Spine surgery: to do or not to do? Who decides? The first scenario is urgent or life-saving surgery, when the physician still takes the lead but the patient and family have the choice. Examples include malignant tumors, spinal fractures and dislocations, and severe nerve damage (foot drop, cauda equina damage – difficulty with urination and defecation or muscle atrophy). The second type is functional surgery (e.g., general cervical radiculopathy, lumbar disc herniation, lumbar spinal stenosis, lumbar spondylolisthesis). The patient’s problem is somatic distress, which does not affect life, but affects work and life. This is what is now often called “quality of life decline”. In this case, from the medical point of view, “serious impact on work and life, conservative treatment is ineffective, then surgery”. From the patient’s point of view, the most important conservative treatment method is bed rest, which can be supplemented by traction, physiotherapy and medication when the indications are clear. If it is really uncomfortable, then surgery can be chosen. 1. In clinical work, we often see that the condition on the film is serious and should be operated; but the patient himself is only a bad film, he does not have any discomfort. In this case, the nature of surgery is “preventive” – to avoid aggravation of symptoms and avoid paralysis. The problem faced by both the patient and the physician is that surgery carries risks, and conservative treatment also carries the risk of exacerbation or even paralysis – it is difficult to tell which is more important and which is less important. At this point, the physician’s role is to inform the patient and family of the pros and cons of surgery and let them decide their “fate”. 2. Clinically, it is also common to see that the severity of the disease is similar on the films of different patients, but the symptoms are very different. For example, the same degree of lumbar disc herniation, some patients have been very painful, and some patients only slightly discomfort. At this point, it is also the patient who decides whether to operate or to be conservative, based on his or her own feelings and judging the degree of discomfort (which can only be stated clearly by him or herself and cannot be replaced by others). It is not the film that decides whether to operate or not. 3. Clinically, we can also see that the patients’ degree of “discomfort” is similar, but the patients’ attitudes are very different. For example, the same lumbar spondylolisthesis, the same can only walk 200 meters, some patients feel that they can still take care of themselves, this is “enough”, choose conservative treatment; some patients can not accept this, because he (she) also want to travel, go to the park. In other words, different people have different attitudes towards life and different quality of life requirements, so how to treat them is different from person to person. The risk of surgery at this point is surgical complications; and conservative treatment is not really effective, so you can only delay the progress of the disease and face the problem of another 3 to 5 years, by which time the risk of surgery is even greater – because the body is aging + accompanied by hypertension and diabetes, etc. (due to the small amount of exercise leading to a decline in heart and lung function). At this point, the risks and benefits of various treatments need to be weighed by the patient himself, with the family assisting in counseling and the physician providing information. The third type is cosmetic surgery (non-serious deformities, benign stationary tumors). It is entirely a patient decision. The second most common type of surgery is called “elective surgery” in medical practice. What you need to do before surgery: The decision to have surgery or not to have surgery is entirely in your hands, and all you have to do is make the final choice. Therefore, it is very important for you to consider as thoroughly as possible the pros and cons of having the surgery and the risks and benefits you will face, as well as the probability of success. You should learn and understand everything about your current medical condition (diagnosis) and the recommended procedure (procedure) before surgery. Ask your physician as many questions as possible about the situation to ensure that you understand in your own mind why this procedure needs to be done, how it will be done, the post-operative recovery process, and the expected results. You can ask your doctor if he or she can give you any written information or direct you to information about the procedure, such as books, pamphlets, websites, videos, etc., to help you better understand your condition and the procedure you are about to have. Most spine surgeries are considered safe today, but you still need to carefully discuss with your surgeon some of the risks associated with the procedure. Any surgery is accompanied by a certain percentage of complications (such as wound infections, anesthesia accidents, etc.). Many spine surgeries also come with additional risks, such as numbness in the limbs due to nerve root injury, paralysis due to spinal cord injury, or difficulty with urination and defecation. Before you agree to any surgery, it is important to understand all of the possible complications associated with the procedure. You need to “weigh the risks versus the benefits”. While you may be deterred by the risks of surgery, you must also consider the risks you may face if you do not have surgery, such as persistent pain, further nerve damage, or even permanent disability. It is important for you to understand what is affecting your quality of life and how it will affect your life if you do not have surgery. If you decide to have surgery, you need to prepare: you should adjust your physical and mental state before surgery, such as diabetes, hypertension and other comorbidities should be well controlled, and drugs such as reserpine and aspirin should be stopped for a period of time.